Rationale for the current surgical management of gastric adenocarcinoma.

Gastric resection remains the primary curative treatment for adenocarcinoma of the stomach. However, the majority of patients continue to present with advanced disease, for which curative resection is impossible. Even when curative resection is technically feasible, local and regional treatment failures are common. No successful adjuvant therapy for gastric adenocarcinoma has been developed to date. In an effort to improve the poor results of resection, "radical gastrectomy," as promoted by Japanese surgeons, has been adopted in some US centers as the primary curative operation for gastric cancer. Only a few controlled clinical trials have been conducted to evaluate the influence of the extent of resection on survival and local disease control. Until the results of current clinical trials are available, radical gastrectomy should be used selectively in the management of gastric cancer.